Gigi Perez
Flemington,NJ
Summary
Highly accomplished Quality Assurance and Quality Improvement expert with several years of dedicated experience in the Quality Management sector. I possess a strong track record of significantly enhancing operational efficiencies, driving continuous improvement initiatives, and consistently ensuring stringent compliance with industry standards. My expertise lies in developing and implementing robust Quality Improvement systems, effectively leading diverse cross-functional teams, and cultivating an environment of sustained excellence. I am proficient in various quality tools and project management methodologies, with a keen ability to analyze complex data, solve intricate problems, and achieve critical organizational goals. As a collaborative team player with excellent communication skills, I am driven, self-motivated, and eager to contribute to organizational success through hard work, meticulous attention to detail, flexibility, and outstanding organizational prowess. I am motivated to grow and excel within the field of Quality Management.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Director of Quality Management
AmeriHealth Caritas Family of Companies -PerformCare
12.2023 - Current
- Progressed through the ranks to senior management, overseeing
- Implemented best practice policies that adhere to Medicaid regulations.
- Audited departments and reported findings to department heads for improvements.
- Enforced compliance with government regulations and company policies.
- Conduct comprehensive Quality Improvement initiatives.
- Lead the development of the Annual Outcomes Management and Quality
- Improvement contract Deliverable Plan.
- Continuously monitor, evaluate, and improve the processes of delivering behavioral health services.
- Standardize processes to follow industry standards.
- Coordinate with internal departments to provide an integrated approach to quality of care.
- Monitor contract deliverables and contracted metrics.
- Ensure policies and procedures are reviewed and revised annually.
- Analyze service utilization trends, outliers, and length of stay in each service.
- Identify and analyze utilization of services.
- Measure and report on point-in-time and longitudinal outcomes.
- Implement outcome measures with input from participating subscribers and stakeholders.
- Ensure accuracy of data and conduct data quality assurance reviews.
- Manage projects and implement enhancements using PDSA, DMAIC, and RACI models.
- Create and maintain quality performance metrics to track and monitor
- improvement efforts, resulting in a 15% increase in efficiency.
- Conduct regular audits and inspections to identify opportunities for improvement and ensure adherence to quality standards.
- Applied coaching techniques and tools to support managers and team members in improving performance.
Clinical Quality Management Manager
AmeriHealth Caritas Family of Companies- PerformCare
11.2019 - 12.2023
- Successfully served as Acting Director for a 6-month period.
- Identified at-risk youth and provided trend information across systems via data and dashboards.
- Investigated and tracked quality-of-care through the resolution of complaints and grievances.
- Utilized Continuous Quality Improvement (CQI) tools to enhance processes and decrease inefficiencies.
- Promoted health equity and reduced barriers to healthcare through robust quality assurance initiatives.
- Conducted routine and targeted behavioral health reviews and audits.
- Demonstrated a comprehensive understanding of healthcare services provided to youth and families.
- Reviewed and processed record release requests within established service level agreements.
- Identified racial and ethnic disparities through targeted data studies.
- Managed and resolved complaints, reconsiderations, and appeals.
- Completed and analyzed complaint trends.
- Managed 5-8 stakeholder-requested projects concurrently.
- Coordinated with cross-functional teams to identify process gaps and develop solutions.
Clinical Manager
Penn Medicine Princeton Health
11.2017 - 11.2019
- Coordinated day-to-day operations for a Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP).
- Assisted with the successful rebranding of a teen-girls program into an all- gender Dialectical Behavior Therapy (DBT) program.
- Managed a comprehensive behavioral health program for youth and adults
- addressing trauma, abuse, gender identity, and eating disorders.
- Chaired the monthly Quality Assurance meeting, analyzing data trends, patient
- satisfaction scores, and quality of patient care.
- Participated in Root Cause Analyses for critical incidents, including fatalities and suicide attempts.
- Identified opportunities to improve clinical practices, devised strategies and implemented plans to increase patient care standards and enhance operational procedures.
- Regularly evaluated employee performance and provided feedback.
- Actively participated in diversity and inclusion initiatives and events.
Lead Therapist
Carrier Clinic
11.2016 - 11.2017
- Developed and implemented intensive individualized treatment plans addressing family relationship problems, destructive patterns of behavior and other psychosocial issues.
- Maintained and updated patient records, changes in service plans and treatment reports.
- Documented patient information, treatment plans, and patient responses.
- Counseled individuals, groups, and families to bring awareness of problems, deal with crisis situations and develop action plans.
- Utilized Cognitive Behavioral approach to treat adult patients.
- Completed bio-psychosocial assessments and the Addiction Use Disorder Identification Test (AUDIT)
- Adhered to Medicaid guidelines to ensure the proper treatment was being delivered and treatment was comprehensive and individualized
- Facilitated group counseling sessions to support and encourage client growth.
Director of Psychiatric Screening
Somerset County
10.2006 - 10.2015
- Managed the daily operations of a 24/7/365 emergency screening department.
- Responsible for the continuity of clinical case flow and ongoing communication with hospital staff.
- Conducted community trainings to law enforcement to enhance their understanding of screening services.
- Monthly review of data trends and areas of improvement in the Systems Review Committee (SRC)
- Conducted internal chart audits to ensure documentation was of high quality.
- Successfully reduced the number of patient referrals to the state hospital.
- Participated and supported the implementation of telehealth services for patients.
- Improved patient care by having a unit psych nurse.
- Implemented express care for children and adolescents who required screening experiences.
- Assisted program administrator with the with the completion of budgetary demands.
- Implemented peer chart reviews and clinical reviews for clinical decision making.
- Spearheaded innovative approaches to resource allocation and strategic planning.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
- Assisted in recruiting, hiring and training of team members.
- Scheduled employees for shifts, taking into account customer traffic and employee strengths.
- Onboarded a security team for patient and staff safety.
Crisis Counselor Team Lead
Mental Health Assoiciation
11.2012 - 05.2013
- A FEMA funded project which helped families cope with mental stress imposed by Hurricane Sandy
- Utilized the Psychological First Aid Model Tool
- Oversaw staff scheduling and led weekly team meetings.
- Provided case management, linkage to mental health services.
- Responsible of data collection, presentations to community providers and media.
- Supported individuals dealing with mental health and emotional issues.
- Collaborated with other professionals to coordinate comprehensive care for clients.
- Adapted counseling techniques to best suit individual needs of each client.
- Designed safe and supportive environment for clients to discuss issues.
Clinician II
UBHC-UMDNJ
10.2004 - 10.2006
- Promoted through the ranks to clinician II.
- Responsible for the academic training for screening centers throughout New Jersey
- Delivered high quality screener re-certification training.
- Reviewed and approved screener certification applications.
- Facilitated communication between provider agencies and DMHAS.
- Identified, and negotiated contracts with vendors and presenters.
- Maintained academic database to identify expired certifications.
- Identified and offered courses and seminars requested by attendees.
Clinician III
UBHC-UMDNJ
10.2001 - 10.2004
- Conducted of psychiatric screening evaluations to determine a client’s appropriate level of care.
- Treated at-risk children and adolescents
- Juvenile Detention Center & Middlesex and Somerset County shelters.
- Established appropriate course of treatment and implemented interventions.
- Provided patients with detailed information about symptoms, causes and treatment expectations.
Education
Master of Arts - Counseling Psychology
Rider University
Trenton, NJ05-2008
Master of Arts - Clinical Psychology
New Jersey City University
Jersey City, NJ05-2001
Skills
- Conflict resolution techniques
- External quality assessment
- Audit plans
- Performance metrics development
- Qualitative analysis
- Decision-making
- Continuous improvement techniques
- Consumer complaint tracking
- Analytical thinking
- Root-cause analysis
- Risk management
- Quality improvement dashboards
- Compliance
- Six sigma methodologies
- Team development
Certification
Lean Six Sigma Green Belt (LSSGB), SSGI, March 2024
Certified Lean Healthcare Professional (CLHP), SSGI, April 2024
Languages
Spanish
Native or Bilingual
Timeline
Director of Quality Management
AmeriHealth Caritas Family of Companies -PerformCare
12.2023 - Current
Clinical Quality Management Manager
AmeriHealth Caritas Family of Companies- PerformCare
11.2019 - 12.2023
Clinical Manager
Penn Medicine Princeton Health
11.2017 - 11.2019
Lead Therapist
Carrier Clinic
11.2016 - 11.2017
Crisis Counselor Team Lead
Mental Health Assoiciation
11.2012 - 05.2013
Director of Psychiatric Screening
Somerset County
10.2006 - 10.2015
Clinician II
UBHC-UMDNJ
10.2004 - 10.2006
Clinician III
UBHC-UMDNJ
10.2001 - 10.2004
Master of Arts - Counseling Psychology
Rider University
Master of Arts - Clinical Psychology
New Jersey City University
Similar Profiles
Diane WiltDiane Wilt
Clinical Care Reviewer at AmeriHealth Caritas Family of CompaniesClinical Care Reviewer at AmeriHealth Caritas Family of Companies
Kevin A. FAISON, SR.Kevin A. FAISON, SR.
Director, Member, and Community Engagement at AmeriHealth Caritas Family of CompaniesDirector, Member, and Community Engagement at AmeriHealth Caritas Family of Companies
DANIEL E. HOLLINSWORTHDANIEL E. HOLLINSWORTH
Information Systems Engineer I at AmeriHealth Caritas Family of CompaniesInformation Systems Engineer I at AmeriHealth Caritas Family of Companies
Asya JonesAsya Jones
Grievance and Complaints Associate at AmeriHealth Caritas Family of CompaniesGrievance and Complaints Associate at AmeriHealth Caritas Family of Companies
Aimee JimenezAimee Jimenez
Kindergarten Teacher at Linden Public SchoolsKindergarten Teacher at Linden Public Schools